AB1281 PREDICTIVE FACTORS FOR FAILURE OF NON-OPERATIVE TREATMENT OF SPONDYLODISCITIS ASSOCIATED WITH SPINAL EPIDURAL ABSCESS
Authors: M. Ghali, M. Ardhaoui, J. Mahbouba, S. Zrour, I. Bejia, M. Touzi, N. Bergaoui
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Spinal epidural abscess (SEA) associated with infectious spondylodiscitis is a rare but serious pathology. It is a serious complication and difficult to diagnose at an early stage. With enough knowledge of risk factors and clinical features, it may be possible to reduce diagnostic delay and treatment failure. <h3>Objectives</h3> The objective of our work was to describe the clinical, radiological, therapeutic, and evolutionary particularities of SEA during infectious spondylodiscitis and to determine factors associated with the failure of conservative treatment. <h3>Methods</h3> We conducted a retrospective study of 54 cases of SEA associated with infectious spondylodiscitis over a period of 13 years [January 2009-April 2022] in the rheumatology department of the Fattouma Bourguiba University Hospital of Monastir. The diagnosis of SEA was retained in clinical, biological, and radiological data. <h3>Results</h3> The mean age was 54 ± 13.52 years [23-82]. A female predominance was observed with a sex ratio (M/F) of 0.92. Thirty-seven patients or 68.5% had at least one comorbidity. Diabetes was the most frequent comorbidity (33.3%). All our patients had back pain on admission. Motor deficits were reported in 48% of the patients with the heaviness of the limbs. Fever was reported in 46.3% of cases. Physical examination revealed spinal stiffness in 23.3% of the patients, motor deficit in 37%, sharp osteotendinous reflexes in 18.5% of the patients, and abolished in 9.25%. The blood tests showed hyperleukocytosis in 18 patients (36%). An erythrocyte sedimentation rate greater (ESR) than 100 mm at the first hour was found in 17 patients. C-reactive protein (CRP) greater than 100 mg/ml was found in 14 patients. 64.8% had pyogenic spondylodiscitis (mainly Staphylococcus aureus), 11.1% had brucella spondylodiscitis and 24.1% had tubercular spondylodiscitis. MRI confirmed the diagnosis of SEA in all cases. The lesions were located at the cervical level in 9.25% of cases, at the dorsal level in 24.07%, and at the lumbar level in 48.14% of cases. The lesions were anterior in 64.8% of cases and anterolateral in 35.2% of cases. The involvement was uni-focal in 63% of cases and extensive in 37% of cases. All our patients had received antibiotic therapy, initially probabilistic and then adapted to the bacteriological results. Immobilization of the spine was indicated in all our patients. Six patients had undergone decompressive surgery after failure of conservative treatment and worsening of the neurological deficit. This treatment consisted of a decompressive laminectomy with debridement of infected tissues. SEA was more frequent in elderly patients (p=0.038), those with a neurological deficit (p=0.016), the presence of spinal cord compression (p=0.04), and in multifocal involvement (p=0.01). When comparing the spinal epidural abscess groups according to the isolated germ, only the diagnostic delay was significantly more important in the course of the brucella SEA (p &lt;0.004). Factors associated with poor evolution under conservative treatment were: diagnostic delay with OR = 0.324 [IC à 95%:0.135-0.777] (p=0.01), neurological deficit with OR = 2.418 [1.187-4.926] (p&lt;0.001), spinal cord compression with OR = 2.77 [1.5-5.07] (p&lt;0.001), and alteration of the general state with OR = 1.41 [1.05-1.87] (p=0.041). <h3>Conclusion</h3> The classical clinical triad of the infectious SEA (back pain + fever + neurological deficit) is not specific enough, hence the delay in diagnosis which has a negative influence on the prognosis. MRI and bacteriological investigation confirms the diagnosis. Early surgical intervention with intravenous antibiotic therapy may be the best choice, especially in patients with progressive neurological deficits. Conservative treatment may be indicated for some patients. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.